A case of successful conservative management for retroperitoneal perforation of duodenal diverticle

Abstract

A patient, 40-year-old female, was admitted on an emergent basis with the diagnosis of perforation of the duodenal diverticle. CT study revealed a wide spread retroperitoneal emphysema extending from around the inferior vena cava immediately below the diaphragm down to the pelvis, but there was no retention of fluid. Blood study did not reveal the elevation of the markers of inflammation. The conservative management with no oral intake, intravenous infusion of fluid, continuous aspiration through nesogastric tube, antibiotics and administration of proton pump inhibitors was successful. Perforation of duodenal diverticle is a relatively rare pathology and there is no consensus of its treatment. We report here a successful case of conservative treatment for the perforation of duodenal diverticle and evaluated the indication of this type of treatment. If the contamination of the retroperitoneal cavity is severe, an operation should probably be performed, but in case the contamination is not severe and start of the treatment is prompt, a conservative treatment chould be possible. In case the inflammatory reaction gets worse with deterioration of the general condition, an immediate laparotomy with drainage procedure may be necessary.